So consider Ford’s last few months of life. He was admitted to hospital last January for pneumonia. Then spent much of July in hospital in Vail; then went to the Mayo Clinic for not one but two angioplasties in August. Then went back into hospital in California in October, and now has died in December. All that time he was obviously going to die within a year or so, and all that time he was at least 92 years old.

My guess is that over the last 12 months of his life well in excess of $100,000 was spent on his health care. And that money probably extended his life by three months at most.

Do we often perform “heroic measures” on people who might not want it, or don’t receive any quality of life benefit from it? Absolutely. Now maybe Holt has an in with the Ford family, or was following his health very closely, but there’s no way for me to know that he was “obviously going to die within a year or so.” Yes, he was 93, yes, he had had several hospital admissions. These are not Good Signs. But still–ask any doctor: internist, geriatrician, palliative care specialist–and they’ll all tell you we’re shitty at predicting when someone’s going to die. Because there’s definitely 93 year-olds out there that get a pneumonia, get really sick, but then recover and end up living 10 more years.

I’m all in favor of having people have these discussions with their family members–living wills, durable powers of attorney–but how can we tell if Ford was gonna kick it until 103?

Comments

John W. Thompson, MD:

If you want to look at another case where there was, what I consider to be a poor use of medical resources, look into the surgery that Dr. Michael DeBakey had for an aortic aneurysm. The NY Times reported that the surgery and post op care cost about $1 million dollars. DeBakey was 97 at the time of his surgery.

h luce:

why would any surgery and post-op care cost $1 million? What would this have cost in a country with single-payer health care?

“why would any surgery and post-op care cost $1 million? What would this have cost in a country with single-payer health care?”
Currently we have a 3 tier health care system in this country- crappy care for the poor/medicaid, good care for the insured middle class, and excellent care for the rich and privileged. A single-payer system would combine the poor and middle class into a tier getting fair care; the rich and privileged would continue to get excellent care (they would pay extra for superior care, or use political pull to get extra care).

Anonymous:

I’m not a medical person, just the daughter of a 96 yr old father who died in 2004 from what I now know was an overdose (or he just couldn’t tolerate) the fentanyl pain patch. The above posts hits home for me. I get the feeling that some doctors (including my dad’s)wants to call the shots on when someone had been treated long enough, and when they can just overdose these elderly people on deadly coctails of drugs. My father was on Vicodin, Xanax, Duragesic Pain Patch to name a few. He was not in any end stage cancer or did not have any life threatening sickness. In fact, he was not even in any chronic pain. I have always felt that one of two things happened: first, his doctor made the decision that enough money had been spent on my father. Yes, he would ocassionally be admitted for things like, dehydration or maybe a urinary tract infection. I feel that from all the facts and looking back, his doctor knew the fentanyl would kill him. Second, he might have been just totally ignorant of the dangers of fentanyl given to the elderly. Heck, I’m no doctor, but after I read the warnings and research it on the internet, all the signs were there, “don’t give it to the elderly, unless they are in chronic pain, and mainly unless doctor gets informed consent. He did not get consent, and even after I became suspicious after witnessing the depressed breathing, sweating, swelling, hallucinating, my family asked that the patch be removed. The doctor never even attempted to give naxolone or narcan to counteract the fentanyl. I found out about the counteracting drugs from the internet. I guess there are opposing opinions, but I wonder if the tables are turned (and trust me they will) and a doctor is put in that position (of someone calling the shots on when “enough money have been spent on their care” ) how will you react?? Keep living, and one day, some other doctor just might get a chance to keep you living, or give you something that will take you out. No lawsuit could be filed, the only recourse was I filed a complaint with the state medical board and clearly pointed out all the things the doctor did that was clearly below the standards of care, and their response was that the doctor did all the “right” things. I expected that answer, after all, my father was old and money spent on him would be better spent on someone younger.

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This is a medical weblog--a collection of thoughts about medicine, medical training, and health policy--written by a fifth-year medical student.

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